High Intensity Interval Training (HIIT) As A Potential Countermeasure For Phenotypic Characteristics of Sarcopenia: A Scoping Review

SYSTEMATIC REVIEW
published: 24 August 2021

doi: 10.3389/fphys.2021.715044
High Intensity Interval Training (HIIT)

as a Potential Countermeasure for
Phenotypic Characteristics of
Sarcopenia: A Scoping Review
Edited by:
Hamdi Chtourou, Lawrence D. Hayes 1*† , Bradley T. Elliott 2† , Zerbu Yasar 3† , Theodoros M. Bampouras 4,5† ,
University of Sfax, Tunisia Nicholas F. Sculthorpe 1† , Nilihan E. M. Sanal-Hayes 6† and Christopher Hurst 7,8†
Reviewed by:
1
Ellen Freiberger, School of Health and Life Sciences, University of the West of Scotland, Hamilton, United Kingdom, 2 Translational
University of Erlangen Physiology Research Group, School of Life Sciences, University of Westminster, London, United Kingdom, 3 Active Ageing
Nuremberg, Germany Research Group, Institute of Health, University of Cumbria, Lancaster, United Kingdom, 4 Lancaster Medical School,
J. Matthew Hinkley, Lancaster University, Lancaster, United Kingdom, 5 The Centre for Ageing Research, Lancaster University, Lancaster,
AdventHealth, United States United Kingdom, 6 Department of Psychology, Lancaster University, Lancaster, United Kingdom, 7 AGE Research Group,
Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom, 8 National Institute
*Correspondence: for Health Research Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals National Health Service
Lawrence D. Hayes Foundation Trust and Newcastle University, Newcastle upon Tyne, United Kingdom
Lawrence.Hayes@UWS.ac.uk
† ORCID:
Background: Sarcopenia is defined as a progressive and generalized loss of skeletal
Lawrence D. Hayes
orcid.org/0000-0002-6654-0072 muscle quantity and function associated predominantly with aging. Physical activity
Bradley T. Elliott appears the most promising intervention to attenuate sarcopenia, yet physical activity
orcid.org/0000-0003-4295-3785
Zerbu Yasar
guidelines are rarely met. In recent years high intensity interval training (HIIT) has garnered
orcid.org/0000-0001-8838-7286 interested in athletic populations, clinical populations, and general population alike. There
Theodoros M. Bampouras is emerging evidence of the efficacy of HIIT in the young old (i.e. seventh decade of
orcid.org/0000-0002-8991-4655
Nicholas F. Sculthorpe life), yet data concerning the oldest old (i.e., ninth decade of life onwards), and those
orcid.org/0000-0001-8235-8580 diagnosed with sarcopenic are sparse.
Nilihan E. M. Sanal-Hayes
orcid.org/0000-0003-4979-9653 Objectives: In this scoping review of the literature, we aggregated information regarding
Christopher Hurst HIIT as a potential intervention to attenuate phenotypic characteristics of sarcopenia.
orcid.org/0000-0002-7239-6599
Eligibility Criteria: Original investigations concerning the impact of HIIT on muscle
Specialty section: function, muscle quantity or quality, and physical performance in older individuals (mean
This article was submitted to
Exercise Physiology,
age ≥60 years of age) were considered.
a section of the journal Sources of Evidence: Five electronic databases (Medline, EMBASE, Web of
Frontiers in Physiology
Science, Scopus, and the Cochrane Central Register of Controlled Trials [CENTRAL])
Received: 26 May 2021
Accepted: 20 July 2021
were searched.
Published: 24 August 2021
Methods: A scoping review was conducted using the Arksey and O’Malley
Citation:
methodological framework (2005). Review selection and characterization were
Hayes LD, Elliott BT, Yasar Z,
Bampouras TM, Sculthorpe NF, performed by two independent reviewers using pretested forms.
Sanal-Hayes NEM and Hurst C (2021)
High Intensity Interval Training (HIIT) as
Results: Authors reviewed 1,063 titles and abstracts for inclusion with 74 selected
a Potential Countermeasure for for full text review. Thirty-two studies were analyzed. Twenty-seven studies had a mean
Phenotypic Characteristics of participant age in the 60s, two in the 70s, and three in the 80s. There were 20 studies
Sarcopenia: A Scoping Review.
Front. Physiol. 12:715044. which examined the effect of HIIT on muscle function, 22 which examined muscle
doi: 10.3389/fphys.2021.715044 quantity, and 12 which examined physical performance. HIIT was generally effective
Frontiers in Physiology | www.frontiersin.org 1 August 2021 | Volume 12 | Article 715044

Hayes et al. HIIT and Sarcopenia Scoping Review
in Improving muscle function and physical performance compared to non-exercised

controls, moderate intensity continuous training, or pre-HIIT (study design-dependent),
with more ambiguity concerning muscle quantity.
Conclusions: Most studies presented herein utilized outcome measures defined by the
European Working Group on Sarcopenia in Older People (EWGSOP). However, there
are too few studies investigating any form of HIIT in the oldest old (i.e., ≥80 years of
age), or those already sarcopenic. Therefore, more intervention studies are needed in
this population.
Keywords: aging, exercise, HIIT, high intensity, power, sarcopenia, sprint, strength
KEY POINTS in mitochondrial function (Melov et al., 2007) and reduced

inflammation (Beyer et al., 2012)] and the functional level [e.g.,
• A variety of intensity prescriptions were utilized in previous improvements in muscle strength and physical performance
experiments, which included “all-out” effort, percentage of (Peterson et al., 2010; Steib et al., 2010)]. To date there remains
maximal heart rate, perceived a percentage of peak oxygen no pharmacological treatment approved for the treatment of
uptake, percentage of intensity at termination of a ramped sarcopenia and resistance exercise training is recommended as its
exercise test, percentage of peak instantaneous power, rating primary treatment (Dent et al., 2018). Given the multi-factorial
of perceived exertion, and percentage of maximum gait speed. nature of sarcopenia, exercise programmes for older adults living
• Twenty-seven studies had a mean participant age in the with sarcopenia often involve a combination of exercise modes
60s, two in the 70s, and three in the 80s. There were (Witham et al., 2020) with the aim of simultaneously improving
20 studies which examined the effect of HIIT on muscle muscular and cardiorespiratory function (Hurst et al., 2019a).
function, 22 studies which examined the effect of HIIT on Offering a range of alternative exercise training approaches
muscle quantity, and 12 studies which examined the effect of which can simultaneously improve multiple outcomes (e.g.,
HIIT on physical function (which are the outcomes used to muscle strength, physical performance, and cardiorespiratory
diagnose sarcopenia). fitness) could help to maximize the potential of exercise as a
• No previous investigation had considered HIIT in a sarcopenic therapeutic strategy for older people living with sarcopenia.
or pre-sarcopenic population, and only three studies were in High intensity interval training (HIIT) has previously been
the oldest old humans. shown to exert substantial cardio-protective effects, across a
range of population groups (Knowles et al., 2015; Hwang et al.,
2016; Batacan et al., 2017; Füzéki and Banzer, 2018; Hannan et al.,
INTRODUCTION 2018; Hayes et al., 2020; Herbert et al., 2021). In the clinical
context, HIIT has been shown to be a safe, feasible and effective
Rationale therapeutic strategy in patients living with diabetes (Little et al.,
Sarcopenia is a progressive skeletal muscle disorder, 2011), heart failure (Angadi et al., 2015) and coronary artery
characterized by reduced skeletal muscle quantity and function disease (Warburton et al., 2005). From a pragmatic perspective,
which is associated with a range of negative health outcomes HIIT can be embedded within the clinical pathway (Way et al.,
including frailty, falls, reduced quality of life, and mortality 2020) and can be delivered using a range of exercise modes (e.g.,
(Cruz-Jentoft and Sayer, 2019; Cruz-Jentoft et al., 2019). In stair climbing, stepping, cycling, walking).
addition to these individual health impacts, sarcopenia places Despite this, much less is known about how HIIT could
a considerable economic burden on healthcare systems with improve elements of muscular structure and function. A
the associated costs in the UK estimated at £2.5 billion per year recent narrative review (Callahan et al., 2021) outlined several
(Pinedo-Villanueva et al., 2019). Taken together, these effects mechanistic explanations as to why HIIT might be anabolic
highlight the need to develop treatment strategies to counteract in nature. These authors called for further investigation of
the deleterious consequences of sarcopenia. HIIT in populations of different age groups and training
Factors including chronic inflammation, mitochondrial status to explore this phenomenon further. Moreover, they
dysfunction, and reduced satellite cell function contribute to proposed HIIT may be beneficial in middle and older age
the onset and progression of sarcopenia (Ziaaldini et al., 2017). where physical conditioning (i.e., aerobic fitness) and increased
Exercise training has the potential to counteract these cellular, muscle quantity were simultaneously desired. Whether HIIT
molecular, and neural alterations (Marzetti et al., 2017; Seo and could provide the necessary improvements in muscle quantity,
Hwang, 2020) with aerobic and resistance exercise capable of quality, and strength, in addition to cardioprotective effects
inducing differential adaptations (Hawley et al., 2014). Previous however, remain unclear (Hurst et al., 2019b). The potential for
work has demonstrated that resistance exercise has multisystem HIIT to simultaneously induce improvements in cardiometabolic
effects, acting at both the physiological [e.g., improvements health and muscular health is an appealing strategy. However,

until now there has not been a comprehensive review of HIIT Eligibility Criteria
within older adults pertaining to phenotypic characteristics of Studies that met the following criteria were included: (1)
sarcopenia using a systematic search strategy. involvement of human participants with a mean age of ≥ 60
Given that exercise programmes delivered to older people years [considered the start of old age (United Nations, 2020)]; (2)
with sarcopenia in clinical practice are varied and often poorly not a review; (3) an intervention which included bouts of high
prescribed (Witham et al., 2020), delivering effective and intensity exercise interspersed with periods of recovery, including
engaging exercise programmes to older people is of prime exercise defined as HIIT or sprint interval training (SIT). We
concern (Dismore et al., 2020; Collado-Mateo et al., 2021). HIIT defined high intensity as exercise >85% peak oxygen uptake
is reportedly enjoyable (Thum et al., 2017), can be completed (VO2peak ) or 85% maximal heart rate (HRmax ) or equivalent
without gym equipment (Blackwell et al., 2017; Dunford et al., perception-based approaches (e.g., Borg 6–20 scale or similar);
2021; Yasar et al., 2021), and deliver self-perceived health and (4) employing an intervention design and include an exercise
fitness improvements (Knowles et al., 2015). However, before training period of >2 weeks; (5) including HIIT in isolation
HIIT can be proposed as a viable countermeasure to phenotypic or performed in combination with another form of exercise;
characteristics of sarcopenia, it is important to consider the (6) including outcome measures related to either (i) muscle
existing literature in terms of methodologies, quality of research function (either strength or power), (ii) muscle quantity, or (iii)
and heterogeneity, to determine whether a systematic review and physical performance.
meta-analysis is possible, and if not to identify the areas in which
the current literature is deficient. A comprehensive review of Search Strategy
HIIT and its effect on phenotypic characteristics of sarcopenia is The search strategy consisted of a combination of free-text
important for clinicians and exercise practitioners to ensure they and MeSH terms relating to “high-intensity interval training,”
are equipped to support community-dwelling older adults and “sarcopenia,” and “older adults” which were developed through
their families/caregivers. Therefore, it seemed prudent to conduct examination of previously published original and review articles
a scoping review in this area to map the existing literature in (e.g., screening of titles, abstracts, keywords). Filters were applied
terms of the volume, nature, and characteristics of the primary to ensure that only records published in English language
research (Arksey and O’Malley, 2005). We used a scoping review involving human participants were included in the search results.
rather than systematic review and meta-analysis because our Full search terms and the complete search strategy can be found
aim was not to ask a precise question and were more interested in the online Supplementary Material associated with this article
in the characteristics of investigations conducted (Munn et al., (Supplementary Material 1).
2018). Moreover, the topic has not yet been extensively reviewed
and may have been complex or heterogeneous in nature. If
existing research was heterogeneous, a systematic review and Information Sources
meta-analysis would not have been possible, and therefore we Five electronic databases (Medline, EMBASE, Web of Science,
opted to scope the area in this manuscript (Mays et al., 2001). Scopus, and the Cochrane Central Register of Controlled Trials
[CENTRAL]) were searched to identify original research articles
Objectives published from the earliest available up until 12th March 2020.
We aimed to provide an overview of existing literature relating Reference lists from included studies and previously published
to phenotypic characteristics of sarcopenia pre- and post-HIIT review articles were examined for potentially eligible papers.
in older adults. The four specific objectives of this scoping
review were to (1) conduct a systematic search of the published Study Selection
literature for the effect of HIIT on muscle strength, muscle Data were extracted by two reviewers (LH & CH) independently
quantity or quality, and physical performance [aligned to the and compared in an unblinded and standardized manner. Once
2018 operational definition of sarcopenia (Cruz-Jentoft et al., each database search was completed and manuscripts were
2019)] in older adults, (2) map characteristics and methodologies sourced, all studies were downloaded into a single reference
used and classified as “HIIT” within the interventions, (3) list with duplicates removed. Titles and abstracts were then
outline the range and characteristics of outcome variables used, screened for eligibility and full texts were only retrieved for
and (4) provide recommendations for the advancement of the studies with HIIT incorporated. Two reviewers then read and
investigative area. coded all the included articles using the PEDro scale (de
Morton, 2009). Full texts were then thoroughly assessed using
METHODS the complete eligibility criteria with first (LH) and last (CH)
authors confirming inclusion and exclusion. Following this
Protocol and Registration quality assessment, the same reviewers read and coded each
The review was conducted and reported according to the of the studies and assessed the following moderators: design
Preferred Reporting Items for Systematic Reviews and method (randomized control trial; RCT, controlled trial; CT
Meta-Analyses extension for scoping reviews (PRISMA- or uncontrolled trial; UCT), combined or HIIT in isolation,
ScR) guidelines (Tricco et al., 2018) and the five-stage framework and outcome variable. Furthermore, participant descriptions and
outlined in Arksey and O’Malley (Arksey and O’Malley, 2005). A training programme variables were extracted with as much detail
review protocol was not published. provided by the authors. Any disagreement between reviewers

FIGURE 1 | Schematic flow diagram describing exclusions of potential studies and final number of studies.
was discussed in a consensus meeting, and unresolved items were resulting in 74 full-text articles being screened. Of these, 42 were
addressed by a third reviewer. excluded and 32 remained.
Data Items Study Characteristics

Data extracted from each study included sample size, group Of the 32 studies included, 14 were RCTs (Adamson et al.,
descriptions, study design, analysis method, and outcome data. 2014, 2020; Hwang et al., 2016; Coetsee and Terblanche, 2017;
Methodological quality was assessed using the modified 0– Sculthorpe et al., 2017; Aboarrage Junior et al., 2018; Malin
10 PEDro scale (de Morton, 2009). The primary outcome et al., 2018; Martins et al., 2018; Ballesta-García et al., 2019;
variables were defined as muscle strength or power, muscle Hurst et al., 2019c; Jiménez-García et al., 2019; Nunes et al.,
quantity or quality, and physical performance, pre- and post- 2019; Taylor et al., 2019; Coswig et al., 2020), one was a quasi-
intervention. There was heterogeneity in study inclusion criteria, experimental, non-randomized, single-blinded controlled study
interventions, assessment tools, and outcomes, thus a pooled (Losa-Reyna et al., 2019), 16 were observational cohort studies
analysis was not appropriate. (Bruseghini et al., 2015, 2019; Boereboom et al., 2016; Guadalupe-
Grau et al., 2017; Hayes et al., 2017; Herbert et al., 2017a,b;
RESULTS Robinson et al., 2017; Wyckelsma et al., 2017; Andonian et al.,
2018; Bartlett et al., 2018; Buckinx et al., 2018, 2019; Søgaard
Study Selection et al., 2018, 2019; Snijders et al., 2019), and one was a pilot
Following the initial database search, 1,267 records were study (although randomized; (Beetham et al., 2019) (Table 1).
identified (Figure 1). Once duplicates were removed, 1,063 Where a study had multiple outcome measures, they were
titles and abstracts remained, and were screened for inclusion, examined separately. Three out of 32 (9%) included HIIT in

TABLE 1 | General study information of investigations concerning HIIT and phenotypic characteristics of sarcopenia.
Frontiers in Physiology | www.frontiersin.org
Hayes et al.
Reference Population Study design Study protocol Intervention characteristics Outcome(s) PEDro
available/ score
Preregistered Duration Total sessions Exercise protocol Exercise Adherence/ Adverse events
(weeks) intensity Compliance/
Attendance
Aboarrage 25 untrained females total, 15 RCT No 24 weeks 72 5 min warm-up preceded All-out >90% inclusion criteria “No participants in Muscle quantity 5
Junior et al. in training group (aged 65 ± 7 jump-based SIT (20 min of 20 either group left Physical
(2018) years); normal body mass; repetitions of 30 s work, 30 s the study or performance
disease free. rest); 5 min cool-down on a Presented any
cycle ergometer. injuries as result of
the exercise
program”
Adamson 12 untrained older adults in RCT No 6 weeks 12 6–10 6 s sprints on a cycle All-out - Not reported Physical 5
et al. (2014) total, 6 in training group (aged ergometer against ∼7% body performance
65 ± 4 years); normal body mass,∼ 60 s rest.
mass; disease free.
Adamson 34 untrained older adults, 11 in RCT No 8 weeks 8 for the once 6–10 6 s sprints on a cycle All-out - Not reported Physical 5
et al. (2020) once per week training, and 11 per week ergometer against ∼7% body performance
in twice per week training training group mass,∼ 60 s rest.
group (aged 65 ± 3 years); 16 for the twice
disease free. per week
training group
Andonian 21 untrained, sedentary older Observational The study was 10 weeks 30 5 min warm-up preceded 90 s 80-90% HRR - Not reported Muscle quantity 2
et al. (2018) adults with rheumatoid arthritis cohort study registered with work, 90 s rest); 5 minute
(n = 12; 64 ± 7 years) or ClinicalTrials.gov cool-down on a treadmill.
prediabetes (n = 9; 71 ± 5
years), free of CVD or diabetes,
5
able-bodied.
Ballesta- 54 individuals (n = 18, 66 ± 5 RCT with MICT The study was 18 weeks 36 1–1.5 min work, 2–2.5 min 14–18 on the >80% inclusion criteria. Not reported Physical 6
García et al. years in the HIIT group, n = 18, and non-exercise registered rest). 6–12 intervals. The Borg scale There were registered performance
(2019) 70 ± 9 years in the MICT control prospectively with programme was progressed adverse events in MICT Muscle function
group, and, n = 18, 67 ±69 ClinicalTrials.gov over the 18 weeks. and control groups. Four
years in the control group “Movements of the lower limbs, women in
group), without hypertension or combined with the movements the MICT group and one
a disease that would interfere of in control were lost to
with exercise. the upper limbs with or without follow-up due to eye
external load.” surgery, foot surgery,
clavicle fracture, and two
hip fractures
after a fall. These adverse
events did not occur
during exercise classes.
August 2021 | Volume 12 | Article 715044
Bartlett et al. 12 untrained, sedentary older Observational The study was 10 weeks 30 5 min warm-up preceded 80–90% VO2 99% adherence. Not reported Physical 2
(2018) adults with rheumatoid arthritis cohort study registered with 60–90 s work, 60–90 s rest; reserve performance
HIIT and Sarcopenia Scoping Review

(64 ± 7 years), free of CVD or ClinicalTrials.gov 5 min cool-down on a treadmill. targeted.
diabetes, able-bodied. Time per session was matched 85 ± 5%
at 30 min. achieved.
Beetham 21 individuals with stage 3–4 Randomized pilot The study was 12 weeks 36 5 min warm-up preceded 4 × 80–95% 33/36 for HIIT, 34/36 for None attributed to Muscle quantity 8
et al. (2019) kidney disease (n = 9, 61 ± 6 trial vs MICT registered at the 4 min intervals with 3 min rest peak heart rate. MICT. the intervention.
years in the HIIT group and Australian and on a treadmill. The programme
n = 5, 63 ± 11 years in the New Zealand was progressed over the 12
MICT group), overweight and Clinical Trials weeks.
varied diabetic status. Registry
(Continued)
TABLE 1 | Continued
Hayes et al.
available/ score
Attendance
Boereboom 21 individuals (aged ∼ 67 Observational The study was 31 days 12 2 min warm-up preceded 5 × 100–110% 12 (full compliance) Not reported Muscle quantity 2
et al. (2016) years) cohort study registered with 60 s intervals with 90 s rest on power achieved
ClinicalTrials.gov a cycle ergometer. during a ramped
CPET protocol
to failure.
Bruseghini 12 healthy older adults (aged Proof-of-concept No 8 weeks 24 10 min warm-up preceded 7 × 85–95% Not reported Not reported Muscle function 2
et al. (2015) 68 ± 4 years). observational 2 min intervals with 2 min rest VO2peak Muscle quantity
cohort study on a cycle ergometer.
Bruseghini 12 moderately active healthy Observational No 8 weeks 24 10 min warm-up preceded 7 × 85–95% Not reported None attributed to Muscle function 2
et al. (2019) men (aged 69 ± 4 years), cohort study 2 min intervals with 2 min rest VO2peak the intervention.
normal body mass, disease on a cycle ergometer. The
free. programme was progressed
every 2 weeks.
Buckinx 33 untrained adults (aged Observational No 12 weeks 36 5 min warm-up preceded 10 × 80–85% peak >80% inclusion criteria Not reported Physical 3
et al. (2019) 69 ± 4 years), non-smoking, cohort dataset 30 s intervals with 90 s rest on heart rate or performance
low alcohol consuming, an elliptical device. The >17 on the Borg Muscle function
postmenopausal (if female), programme was progressed. scale Muscle quantity
without counter-indication to
exercise.
Buckinx 30 untrained adults (aged Observational No 12 weeks 36 5 min warm-up preceded 10 × 80–85% peak >80% inclusion criteria Not reported Physical 3
et al. (2018) 69 ± 4 years), non-smoking, cohort dataset 30 s intervals with 90 s rest on heart rate or performance
low alcohol consuming, an elliptical device. The >17 on the Borg
6
postmenopausal (if female), programme was progressed. scale

without counter-indication to
exercise.
Coetsee 67 inactive individuals (n = 13, RCT No 16 weeks 48 4 × 4 min intervals with 3 min 90–95% peak Not reported Not reported Physical 5
and 65 ± 6 years in the HIIT group rest on a treadmill. The heart rate. performance
Terblanche and n = 129, 63 ± 6 years in programme was progressed
(2017) the control group), normal BMI,
no cognitive impairment, and
no comorbidities.
Coswig 46 untrained female nursing RCT with MICT as No 8 weeks 16 5 min warm-up preceded 4 × 85–95% peak >80% inclusion criteria. Not reported Physical 5
et al. (2020) home residents (aged 81 ± 5 a positive control 4 min intervals with 4 min rest heart rate. performance
years), n = 15 in HIIT group. group on a treadmill. The programme Muscle quantity
Comorbidities that did not was progressed
preclude involvement.
Guadalupe- 9 males (aged 84 ± 3 years) Observational No 9 weeks 18 Strength training plus HIIT. “Sprints” at >80% inclusion criteria. Not Not reported Physical 2
Grau et al. with low to severe COPD. cohort study HIIT commenced from the third 80–90% HRR 14 started. 9 completed. performance

(2017) Participants were overweight week: Muscle function
according to BMI, and 4/9 5 min warm-up preceded 4 ×
were sarcopenic. 15 s, progressing to 5 × 25 s
intervals with 60 s rest on a
cycle ergometer.
Hayes et al. 22 sedentary but otherwise Observational No 6 weeks 9 HIIT sessions 6 × 30 s intervals with 3 min 40% PPO or 100% adherence Not reported Muscle quantity 2
(2017) healthy, males (62 ± 2 years) cohort study with HIIT rest on a cycle ergometer. ∼141% power
MICT phase preceded achieved during
by 6 a ramped CPET
weeks protocol to
MICT failure.
(Continued)
Hayes et al.
TABLE 1 | Continued
available/ score
Attendance
Herbert 22 sedentary but otherwise Observational No 6 weeks 9 HIIT sessions 6 × 30 s intervals with 3 min 40% PPO or 100% adherence Not reported Muscle quantity 2
et al. healthy, males (62 ± 2 years) cohort study with HIIT rest on a cycle ergometer. ∼141% power
(2017a) 17 male masters athletes MICT phase preceded achieved during
(60 ± 5 years) by 6 a ramped CPET
weeks protocol to
MICT failure.
Herbert 17 male masters athletes Observational No 6 weeks 9 HIIT sessions 6 × 30 s intervals with 3 min 40% PPO or 100% adherence Not reported Muscle function 2
et al. (60 ± 5 years) cohort study HIIT rest on a cycle ergometer. ∼141% power
(2017b) preceded achieved during
by 6 a ramped CPET
weeks protocol to
MICT failure.
Hurst et al. 36 untrained older adults, who RCT The study was 12 weeks 24 6 min warm-up preceded 4 >90% >90% inclusion criteria. None attributed to Muscle function 7
(2019c) were disease free (n = 18 HIIT; registered with sets of 4 resistance exercises. peak heart rate 99% achieved. the intervention.
aged ∼62 years, n = 18 ClinicalTrials.gov The programme was was targeted.
control; aged ∼63 years). progressed 89% peak heart
rate achieved.
Mean heart rate
was 82%
maximum.
Hwang et al. 51 untrained older adults, who RCT No 8 weeks 32 10 min warm-up preceded 4 × >90% 84% completed the None attributed to Muscle quantity 6
7
(2016) were disease free (n = 15 4 min intervals with 3 min rest of peak heart rate. study. Of those who the intervention.
completed HIIT; aged 65 ± 1 synchronous arm and leg completed the study,
years, n = 15 completed exercise on a non-weight 89% attendance was
control; aged 64 ± 2 years). bearing all-extremity air-braked achieved for HIIT.
ergometer. The programme
was progressed.
Jiménez- 82 healthy older adults 68 ± 5 RCT The study was 12 weeks 24 10 min warm-up preceded 4 × 90–95% >80% attendance as None attributed to Physical 8
García et al. years of age (n = 26 in HIIT) registered with 4 min suspension squats with peak heart rate. inclusion criteria. the intervention. performance
(2019) ClinicalTrials.gov 3 min rest.
Losa-Reyna 20 pre-frail or frail patients Quasi- No 6 weeks 12 Resistance training plus HIIT. 90% maximal 16 started, 11 finished. Not reported Physical 5
et al. (2019) without multiple comorbidities, experimental, 5 min warm-up preceded gait speed performance
84 ± 5 years of age (n = 11 in non-randomized, resistance exercise, and then Muscle function
HIIT) single-blinded 6–10 × 10–30 s with 40–100 s
controlled study rest on a treadmill. The
programme was progressed
Malin et al. Sedentary obese subjects RCT with MICT as No 2 weeks 12 10 × 3 min intervals with 4 min 90% peak heart Not reported Not reported Muscle quantity 5
(2018) (61±3 years) control rest on a cycle ergometer. The rate

programme was progressed
Martins 16 postmenopausal sedentary RCT with The study was 12 weeks 36 5 min warm-up preceded 10 × >85% 14 started, 8 finished. Not reported Muscle quantity 5
et al. (2018) women at high risk of type II combined training registered with 60 s with 60 s rest bodyweight peak heart rate Physical
diabetes (n = 8 HIIT; aged (resistance and ClinicalTrials.gov squats and steps. The performance
64 ± 7 years, n = 8 combined aerobic) as control programme was progressed Muscle function
training; aged 65 ± 6 years).
(Continued)
TABLE 1 | Continued
Hayes et al.
available/ score
Attendance
Nunes et al. 24 postmenopausal obese RCT with The study was 12 weeks 36 5 min warm-up preceded 10 × >85% 13 started, 12 finished. Not reported Muscle quantity 5
(2019) sedentary women (n = 12 HIIT; combined training registered with 60 s with 60 s rest bodyweight peak heart rate 91% adherence Physical
aged ∼63 years, n = 12 (resistance and ClinicalTrials.gov squats and steps. The performance
combined training; aged ∼63 aerobic) as control programme was progressed Muscle function
years).
Robinson 8 untrained older adults Observational The study was 12 weeks 36 4 × 4 min with 3 min rest on a >90% 27 started, 23 finished. Not reported Muscle quantity 3
et al. (2017) (71 ± 6 years), disease free, cohort study with registered with cycle ergometer. VO2peak Muscle function
non-smokers. sedentary control ClinicalTrials.gov
phase, followed by
randomization into
HIIT, combined
training (resistance
and aerobic), or
resistance only
training.
Sculthorpe 22 sedentary older males RCT No 12 weeks, 9 5 min warm-up preceded 6 × 40% PPO for the 100% adherence. None attributed to Muscle quantity 5
et al. (2017) (62 ± 4 years), disease free. of which 6 60 s with 3 min rest on a cycle first 3 sessions, the intervention. Muscle function
weeks ergometer. then 50% PPO
was HIIT for the remaining
6 sessions.
Snijders 14 sedentary men (74 ± 8 Observational The study was 12 weeks 36 Resistance training plus HIIT ∼90% Not reported Not reported Muscle function 2
et al. (2019) years), disease free, cohort study registered with 3 min warm-up preceded 10 x peak heart rate Muscle quantity
8
non-smokers. ClinicalTrials.gov 60 s with 60 s rest on a cycle

ergometer.
Søgaard 22 sedentary older adults (aged Observational No 6 weeks 18 2 min warm-up preceded 5 × >85% power 28 started, 22 finished. Not reported Muscle quantity 2
et al. (2018) 63 ± 1 years), disease free, cohort study 60 s with 90 s rest on a cycle achieved during
non-smokers. ergometer. a ramped
protocol to
failure
(individualized so
participants
could maintain
intensity for
60 s).
Søgaard 22 sedentary older adults (aged Observational No 6 weeks 18 2 min warm-up preceded 5 × >85% power Not reported Not reported Muscle quantity 2
et al. (2019) 63 ± 1 years), disease free, cohort study 60 s with 90 s rest on a cycle achieved during
non-smokers. ergometer. a ramped
protocol to
failure

(individualized so
participants
could maintain
intensity for
60 s).
Taylor et al. 29 older adults (aged 64 ± 8 RCT with MICT as No 12 weeks 36 Not reported Not reported Not reported Not reported Muscle quantity 4
(2019) years) split into HIIT and MICT. control
Wyckelsma 15 older adults (aged 69 ± 4 Observational No 12 weeks 36 3 min warm-up preceded 4 × 90–95% peak Not reported Not reported Muscle quantity 2
et al. (2017) years) disease free. cohort study 4 min with 4 min rest on a cycle heart rate.
ergometer.
RCT, randomized control trial; MICT, moderate intensity continuous training; SIT, sprint interval training; HIIT, high intensity interval training.
a multicomponent intervention (Guadalupe-Grau et al., 2017;

Losa-Reyna et al., 2019; Snijders et al., 2019). Sixteen studies
included HIIT on a cycle ergometer, six included HIIT on a
treadmill, seven included resistance exercise HIIT (including
bodyweight exercises), two included HIIT on an elliptical trainer,
and one study did not detail the intervention. Three studies
used an “all-out” intensity, 15 used a percentage of HRmax
or heart rate reserve (HRR) to prescribe intensity, four used
a percentage of VO2peak to prescribe intensity, three used a
percentage of intensity at termination of a ramped incremental
exercise protocol to prescribe intensity, four used percentage of FIGURE 2 | Schematic representation of frequency of outcome examined
(n = 54) within the 32 included studies concerning HIIT and phenotypic
peak power output to prescribe intensity, one used the Borg scale
characteristics of sarcopenia.
to prescribe intensity, one study used a percentage of maximum
gait speed to prescribe intensity, and one study did not detail
the intervention. Twenty-seven studies had a mean age in the
60s, two in the 70s, and three in the 80s. One study considered HIIT and Muscle Quantity or Quality
frail participants. There were 20 studies which examined the
There were 22 studies which examined the effect of HIIT
effect of HIIT on muscle function, 22 studies which examined
on muscle quantity or a surrogate (fat free mass, lean mass,
the effect of HIIT on muscle quantity, and 12 studies which
thigh volume; Table 3). Of these, 13 measured whole body
examined the effect of HIIT on physical function (Figure 2).
lean mass by dual-energy X-ray absorptiometry (DEXA), nine
Several studies investigated more than one parameter, thus why
measured leg lean mass by DEXA (of these, all nine also
the sum of the studies above is greater than the number of
reported whole body lean mass), one measured whole body lean
included studies.
mass by air plethysmography, one measured M. vastus lateralis
muscle thickness by ultrasonography, two measured quadriceps
muscle volume by magnetic resonance imaging (MRI), two
HIIT and Muscle Function measured quadriceps cross-sectional area (CSA) or anatomical
There were 20 studies which examined the effect of HIIT on
CSA (ACSA) by MRI, one measured whole body lean mass by
muscle function using one or more of the criteria outline by
MRI, one measured thigh muscle area by peripheral quantitative
EWGSOP (Cruz-Jentoft et al., 2019) (Table 2). Of these, 18
computed tomography (pQCT), and six measured whole body
measured muscle strength, and five measured muscle power
lean mass by bioelectrical impedance analysis (BIA). Of the
(some studies measured both, thus why this total is not 20).
22 studies examining muscle quantity or quality outcomes, 11
Of those reporting strength, six used the handgrip test, one
reported ≥1 muscle quantity parameter was improved by HIIT,
used a 30 s arm curl test, five used a 30 s chair stand test,
14 reported no difference in ≥1 measure from pre-intervention
four used the 5 repetitions chair stand test, one used a 10
or vs. a no exercise control, two reported inferior adaptation
repetition chair stand test, two used knee extensor isokinetic
following HIIT compared to a group undertaking resistance
dynamometry, one used a strain gauge for the knee extensors,
training in ≥1 measure, one study reported lean mass was lost
four used a leg press, two used a chest press, three used
post-HIIT to a similar extent as a non-exercise control, and
a knee extension machine (which was not a dynamometer),
one did not report post-intervention lean mass (some studies
and one used latissimus dorsi pull-down, horizontal row, and
measured several outcomes, thus why this total is not 22). There
shoulder press. Of the 20 studies examining strength outcomes,
was no evident relationship between change in muscle quantity
15 reported ≥1 strength parameter having been improved by
(as measured by lean mass) and number of bouts completed
HIIT compared to pre-training or compared to a moderate
(Supplementary Figure 1d).
intensity continuous training (MICT) or non-exercise control.
Of the remaining three (Robinson et al., 2017; Martins et al.,
2018; Nunes et al., 2019), they all reported strength had improved HIIT and Physical Performance
more in a combined aerobic and resistance training group than a There were 12 studies which examined the effect of HIIT
HIIT group. on physical function (Table 4). One used the short physical
There were five studies which examined the effect of HIIT on performance battery (SPPB), eight used gait speed or the 6 min
muscle power, with two studies examining peak power output walk test (6MWT), nine used the timed up and go (TUG)
during cycle ergometry, and the remaining three determined test, and one used the 400 m walk test (some studies utilized
power during a resistance training exercise (leg extension or leg- more than one outcome). Of the 12 studies examining physical
press). One investigation examined power during a 5 repetition performance, all reported ≥1 parameter was improved by
chair stand test (Losa-Reyna et al., 2019). Of these studies, HIIT. The only study examining SPPB reported HIIT improved
all reported improved power output post-HIIT. There was no SPPB performance.
evident association between change in muscle function (either 5 There was no evident relationship between change in muscle
rep chair stand, 30 s chair stand, or grip strength) and number of performance (as measured by TUG and 6MWT) and number of
bouts completed (Supplementary Figures 1a–c). bouts completed (Supplementary Figures 1e,f).

TABLE 2 | Summary of study details concerning HIIT and muscle function.
Reference Method of outcome Summary of results

measurement
MUSCLE STRENGTH
Aboarrage 30 s chair stand test ➚ vs. pre-HIIT, ➚ vs. control
Junior et al. HIIT group 30 s chair stand test was 16 ± 4 repetitions and 19 ± 5 repetitions pre- and post-intervention, respectively.
(2018) Control group 30 s chair stand test was 20 ± 2 repetitions and 19 ± 2 repetitions pre- and post-intervention, respectively.
Adamson et al. 5 rep chair stand test ➚ vs. pre-HIIT, ➚ vs. control
(2014) HIIT group 5 rep chair stand test was 10.5 ± 2.2 s and 9.0 ± 1.6 s pre- and post-intervention, respectively.
Control group 5 rep chair stand test was 12.1 ± 4.9 s and 11.9 ± 4.0 s pre- and post-intervention, respectively.
Adamson et al. 5 rep chair stand test ➚ vs. pre-HIIT, ➚ vs. control
(2020) HIIT once weekly group 5 rep chair stand test was 11.9 ± 1.8 and 10.6 ± 2.1 s pre- and post-intervention, respectively.
HIIT twice weekly group 5 rep chair stand test was 12.0 ± 2.1 s and 9.3 ± 1.1 s pre- and post-intervention, respectively.
Control group 5 rep chair stand test was 12.1 ± 4.3 and 12.3 ± 4.2 s pre- and post-intervention, respectively.
Ballesta-García 30 s arm curl test ➚ vs. pre-HIIT, ➚ vs. control, ➚ vs. MICT
et al. (2019) 30 s chair stand test HIIT group 30 s arm curl test was 28.9 ± 5.2 repetitions and 31.7 ± 5.5 repetitions pre- and post-intervention, respectively.
Control group 30 s arm curl test was 20.6 ± 3.0 repetitions and 22.4 ± 2.9 repetitions pre- and post-intervention, respectively.
MICT group 30 s arm curl test was 25.6 ± 5.2 repetitions and 25.1 ± 4.1 repetitions pre- and post-intervention, respectively.
HIIT group 30 s chair stand test was 15.1 ± 2.7 repetitions and 20.7 ± 3.2 repetitions pre- and post-intervention, respectively.
Control group 30 s chair stand test was 16.8 ± 2.9 repetitions and 14.9 ± 2.9 repetitions pre- and post-intervention,
respectively.
MICT group 30 s chair stand test was 13.7 ± 3.4 repetitions and 17.5 ± 4.9 repetitions pre- and post-intervention,
respectively.
Bartlett et al. 30 s chair stand test ➚ vs. pre-HIIT
(2018) Handgrip strength 30 s chair stand test was 14 ± 4 repetitions and 17 ± 5 repetitions pre- and post-HIIT, respectively.
➞ vs. pre-HIIT
Handgrip strength was 18.3 ± 7.2 and 19.0 ± 8.1 kg pre- and post-HIIT, respectively.
Bruseghini et al. Knee extensor ➚ vs. pre-HIIT, ➘ vs. resistance training
(2015) isokinetic HIIT group isometric knee extensor torque at 60◦ knee flexion was 200 ± 21 Nm and 215 ± 32 Nm pre- and post-intervention,
dynamometry. respectively.
Resistance training group isometric knee extensor torque at 60◦ knee flexion was 202 ± 23 Nm and 223 ± 39 Nm pre- and
post-intervention, respectively.
➞ vs. pre-HIIT, ➘ vs. resistance training
HIIT group isometric knee extensor torque at 90◦ knee flexion was 169 ± 34 and 165 ± 31 Nm pre- and post-intervention,
respectively.
Resistance training group isometric knee extensor torque at 90◦ knee flexion was 166 ± 38 and 177 ± 42 Nm pre- and
HIIT group concentric knee extensor torque at 60◦ · s−1 was 160 ± 24 and 163 ± 22 pre- and post-intervention, respectively.
Resistance training group concentric knee extensor torque at 60◦ · s−1 was 164 ± 26 and 179 ± 31 Nm pre- and
HIIT group concentric knee extensor torque at 120◦ ·s−1 was 130 ± 23 and 133 ± 24 pre- and post-intervention, respectively.
Resistance training group concentric knee extensor torque at 120◦ · s−1 was 132 ± 23 and 139 ± 23 Nm pre- and
Bruseghini et al. Knee extensor ➞ vs. pre-HIIT, ➘ vs. resistance training
(2019) isokinetic Knee extensor isokinetic dynamometry results at 90◦ knee flexion and 120◦ · s−1 are identical to Bruseghini et al. (2015).
dynamometry.
Buckinx et al. 10 rep chair stand test ➚ vs. pre-HIIT
(2018) 10 rep chair stand test was 18.8 ± 3.7 and 15.6 ± 3.7 s pre- and post-HIIT, respectively.
Buckinx et al. Handgrip strength ➚ vs. pre-HIIT
(2019) Knee extensor Relative handgrip strength was 0.41 ± 0.11 and 0.43 ± 0.12 kg·kg−1 pre- and post-HIIT respectively, in a low protein group.
isometric strength Relative handgrip strength was 0.40 ± 0.09 and 0.41 ± 0.08 kg·kg−1 pre- and post-HIIT respectively, in a high protein group.
using a ➞ vs. pre-HIIT
chain-mounted strain Relative knee extensor isometric strength was 9.8 ± 2.5 and 10.1 ± 1.9 N·kg−1 pre- and post-HIIT, respectively, in a low
gauge. protein group.
Relative knee extensor isometric strength was 10.2 ± 1.6 and 10.4 ± 1.6 N·kg−1 pre- and post-HIIT, respectively, in a high
protein group.
Coswig et al. 30 s chair stand test ➚ vs. pre-HIIT, ➚ vs. MICT
(2020) HIIT group 30 s chair stand test was 8.4 ± 1.4 repetitions and 11.8 ± 2.1 repetitions pre- and post-intervention, respectively.
MICT group 30 s chair stand test was 8.5 ± 1.1 repetitions and 11.0 ± 1.6 repetitions pre- and post-intervention,
respectively.
(Continued)

TABLE 2 | Continued

measurement
Guadalupe-Grau 30 s chair stand test ➚ vs. pre-HIIT

et al. (2017) Upper- and lower-limb 30 s chair stand test was 11.9 ± 4.2 repetitions and 17.0 ± 3.8 repetitions pre- and post-HIIT, respectively.
isometric strength Shoulder abduction strength was 10.9 ± 3.8 and 15.8 ± 4.3 kg pre- and post-HIIT, respectively.
using a hydraulic hand Hip flexion strength was 14.8 ± 3.7 and 21.1 ± 4.7 kg pre- and post-HIIT, respectively.
dynamometer. Leg extension strength was 11.9 ± 2.1 and 18.2 ± 2.8 kg pre- and post-HIIT, respectively.
3 RM leg press and 1-RM leg press strength was ∼90 ± 20 and 145 ± 10 kg pre- and post-HIIT, respectively.
chest press. 1-RM chest press strength was ∼22 ± 8 and 40 ± 10 kg pre- and post-HIIT, respectively.
Handgrip strength ➞ vs. pre-HIIT
Handgrip strength was 28.4 ± 5.0 and 30.3 ± 5.2 kg pre- and post-HIIT, respectively.
Hurst et al. Handgrip strength ➞ vs. pre-HIIT, ➞ vs. control,
(2019c) HIIT group handgrip strength was 36.2 ± 10.9 and ∼38.1 kg pre- and post-intervention, respectively.
Control group handgrip strength was 33.9 ± 11.0 and ∼ 33.4 kg pre- and post-intervention, respectively.
Jiménez-García Handgrip strength ➚ vs. pre-HIIT, ➚ vs. control, ➚ vs. MICT
et al. (2019) HIIT group handgrip strength was ∼25 ± 1 and ∼28 ± 2 kg pre- and post-intervention, respectively.
Control group handgrip strength was ∼27 ± 2 and ∼27 ± 2 kg pre- and post-intervention, respectively.
HIIT group handgrip strength was ∼25 ± 2 and ∼26 ± 2 kg pre- and post-intervention, respectively.
Losa-Reyna 5 rep chair stand test ➚ vs. pre-HIIT, ➚ vs. control
et al. (2019) Leg-press HIIT group 5 rep chair stand test was 15.6 ± 2.7 and 10.8 ± 2.5 s pre- and post-intervention, respectively.
force-velocity testing Control group 5 rep chair stand test was 15.7 ± 3.0 and 14.8 ± 4.0 s pre- and post-intervention, respectively.
and 1-RM HIIT group handgrip strength was 16.3 ± 3.6 and 18.3 ± 2.3 kg pre- and post-intervention, respectively.
Handgrip strength Control group handgrip strength was 20.8 ± 6.0 and 20.1 ± 5.7 kg pre- and post-intervention, respectively.
➚ vs. pre-HIIT
1-RM leg-press strength was 49.2 ± 19.0 and 62.4 ± 23.2 kg pre- and post-HIIT, respectively.
Load at peak power leg-press was 36.3 ± 18.1 and 42.3 ± 17.4 kg pre- and post-HIIT, respectively.
Martins et al. 1-RM unilateral knee ➚ vs. pre-HIIT, ➘ vs. combined training
(2018) extension. HIIT group unilateral knee extension strength was 56.2 ± 17.7 and 56.8 ± 21.9 kg pre- and post-intervention, respectively.
Combined training group unilateral knee extension strength was 47.8 ± 8.5 and 64.0 ± 64.0 kg pre- and post-intervention,
respectively.
Nunes et al. 5 rep chair stand test ➚ vs. pre-HIIT, ➞ vs. combined training
(2019) 1-RM unilateral knee HIIT group 5 rep chair stand test was 12.3 (10.2–14.5) s and 9.3 (7.5–11.1) s pre- and post-intervention, respectively.
extension. Combined training group 5 rep chair stand test was 11.0 (9.7–12.4) s and 7.8 (6.8–8.8) s pre- and post-intervention,
respectively.
➚ vs. pre-HIIT, ➘ vs. combined training
HIIT group unilateral knee extension strength was 57.9 (47.6–68.1) and 61.5 (45.7–77.2) kg pre- and post-intervention,
respectively.
Combined training group unilateral knee extension strength was 50.7 (41.1–60.3) and 65.4 (54.8–75.9) kg pre- and
Robinson et al. 1-RM leg press. ➚ vs. pre-HIIT, ➘ vs. combined training, ➘ vs. resistance training
(2017) HIIT group increased 1-RM leg press ∼1.0 kg·FFM−1
leg from pre- to post-intervention.
Combine training group increased 1-RM leg press ∼3.5 kg·FFM−1
Resistance training group increased 1-RM leg press ∼4.3 kg·FFM−1
Snijders et al. 1-RM leg press, chest ➚ vs. pre-HIIT

(2019) press, latissimus dorsi 1-RM leg press was 72 ± 25 and 92 ± 35 kg pre- and post-HIIT, respectively.
pull-down, horizontal 1-RM chest press was 21 ± 6 and 24 ± 7 kg pre- and post-HIIT, respectively.
row, shoulder press, 1-RM latissimus dorsi pull-down was 26 ± 4 and 30 ± 5 kg pre- and post-HIIT, respectively.
and knee extension. 1-RM knee extension was 27 ± 8 and 35 ± 9 kg pre- and post-HIIT, respectively.
➞ vs. pre-HIIT
1-RM shoulder press was 24 ± 7 and 27 ± 8 kg pre- and post-HIIT, respectively.
1-RM horizontal row was 28 ± 9 and 29 ± 5 kg pre- and post-HIIT, respectively.
MUSCLE POWER
Buckinx et al. Leg extensor power. ➚ vs. pre-HIIT
(2018) Leg extensor power was 155 ± 70 and 186 ± 69 W pre- and post-HIIT, respectively.
Herbert et al. Peak power output, ➚ vs. pre-HIIT
(2017a) determined by a 6 s Peak power output was 766 ± 163 and 856 ± 211 W pre- and post-HIIT, respectively.
sprint on a cycle
ergometer.
(Continued)

TABLE 2 | Continued

measurement
Hurst et al. Leg extensor power. ➚ vs. pre-HIIT, ➚ vs. control,

(2019c) HIIT group leg extensor power was 159 ± 65 W and ∼165 W pre- and post-intervention, respectively.
Control group leg extensor power was 162 ± 63 and ∼162 W pre- and post-intervention, respectively.
Losa-Reyna Leg-press ➚ vs. pre-HIIT, ➚ vs. control
et al. (2019) force-velocity testing. HIIT group 5 rep chair stand power was 104 ± 32 and 156 ± 50 W pre- and post-intervention, respectively.
5 rep chair stand test Control group 5 rep chair stand test was 123 ± 23 and 134 ± 35 W pre- and post-intervention, respectively.
power ➚ vs. pre-HIIT
HIIT group 5 leg-press peak power was 113 ± 62 and 153 ± 96 W pre- and post-intervention, respectively.
Sculthorpe et al. Peak power output, ➚ vs. pre-HIIT, ➚ vs. control
(2017) determined by a 6 s HIIT group peak power output was 699 ± 180 and 831 ± 171 W pre- and post-intervention, respectively.
sprint on a cycle Control group peak power output was 655 ± 130 and 657 ± 133 W pre- and post-intervention, respectively.
ergometer.
1-RM, One repetition maximum; MICT, Moderate intensity continuous training; MIIT, Moderate intensity interval training ➚, superior to; ➘, worse than; ➞, equal to (according to statistical
interpretation of original authors). Data are presented as mean ± standard deviation or mean (95% confidence intervals).
DISCUSSION included studies involved participants who had been diagnosed

with sarcopenia using a formalized definition. This limits
This scoping review provided an overview of existing literature the clinical significance of the included literature and clearly
pertaining to HIIT and phenotypic characteristics of sarcopenia. highlights a need for further work in this population.
We examined outcomes according to the revised EWGSOP
definition (Cruz-Jentoft et al., 2019) to facilitate translation of HIIT and Muscle Function
research findings into clinical practice. Firstly, the earliest article According to the revised EWGSOP definition of sarcopenia
cited was Adamson et al. (2014) published in 2014, which (Cruz-Jentoft et al., 2019), muscle function is primarily
speaks to this rapidly emerging area of research. This review considered as muscle strength. Yet, the chair stand test (or
catalogs existing literature, with a view to facilitating discussion its variations) is named as a parameter that measures muscle
of research opportunities and issues that need to be addressed in strength. However, as the chair stand test relies on the ability
future studies. to generate force over a short period of time, this could be
In relation to our first objective, which was to search the considered a test of muscle power, rather than a measure of
literature for the effect of HIIT on phenotypic characteristics of maximal force. The term dynapenia [i.e., the age-associated
sarcopenia in older adults, we observed most studies reported at reduction in muscle strength and power (Clark and Manini, 2012;
least one positive change in characteristics when compared to vs. Manini and Clark, 2012)] was originally used to differentiate
pre-HIIT, vs. non-exercise control, or vs. MICT. In this context, itself from sarcopenia (Clark and Manini, 2008), which has its
19 of 20 studies reported an improvement to ≥1 muscle function roots in age-related reduced muscle mass [Greek translation
outcome for ≥1 comparisons examined (vs. pre-HIIT, vs. non- = “poverty of flesh” (Kim and Choi, 2013)]. However, more
exercise control, or vs. MICT) (Bruseghini et al., 2019). Similarly, recent definitions and diagnoses of sarcopenia have broadened
twelve of 22 reported an improvement to ≥1 muscle quantity to include muscle function. In this context, when one measures
outcome for ≥1 comparison examined, and 11 of 12 reported an muscle strength using non-isometric movements (i.e., when
improvement to for ≥1 physical performance outcome for ≥1 work occurs), force, distance, and time can be extracted, which
comparison examined. is quantification of power. Thus, we believed it pertinent to
In relation to our second objective, training programmes include studies which concerned muscle power within this
ranged in duration from 2 to 24 weeks (median = 9.5 weeks), review. In fact, muscle power associates more strongly with
incorporated resistance training based HIIT, running/walking physical performance and independence than muscle quantity
HIIT, cycling HIIT, and HIIT combined with other exercise (Clark and Manini, 2010; Trombetti et al., 2016), which may
modes (i.e., resistance training). Populations studied were explain why the chair stand test is at the forefront of the revised
commonly in the 7th decade of life, and mostly living EWGSOP algorithm for diagnosing and quantifying sarcopenia
independently. In relation to our third objective, muscle quantity, (Cruz-Jentoft et al., 2019). Moreover, as this is a scoping review,
or quality was most frequently studied in the included literature. our a priori aim was to outline the range and characteristics of
DEXA was the most utilized measurement method, which is in outcome variables examined.
line with the EWGSOP algorithm for sarcopenia case findings In this review, only six studies used grip strength as an
in clinical practice (Cruz-Jentoft et al., 2019). However, these outcome measure (Guadalupe-Grau et al., 2017; Buckinx et al.,
are only routinely found in research facilities and hospitals 2019; Hurst et al., 2019c; Jiménez-García et al., 2019). This is
and would likely require a referral from primary care before interesting to note as EWGSOP propose grip strength as the
an individual received a DEXA scan. Importantly, none of the primary measurement of muscle strength in clinical practice

TABLE 3 | Summary of study details concerning HIIT and muscle quantity or quality.

measurement
Aboarrage Whole body lean mass ➞ vs. control

Junior et al. by DEXA. HIIT group lean mass was 40 ± 6 and 41 ± 6 kg pre- and post-intervention, respectively.
(2018) Control group lean mass was 40 ± 9 and 41 ± 10 kg pre- and post-intervention, respectively.
Andonian et al. Whole body lean mass ➞ vs. pre-HIIT
(2018) by air displacement Rheumatoid arthritis group lean mass was 44.9 ± 8.9 and 44.7 ± 7.8 kg pre- and post-HIIT, respectively.
plethysmography. Prediabetes group lean mass was 50.1 ± 12.2 and 50.1 ± 12.0 kg pre- and post-HIIT, respectively.
Beetham et al. Whole body and lower ➞ vs. pre-HIIT, ➞ vs. MICT
(2019) limb lean mass by HIIT group low limb lean mass was 17.6 ± 6.6 and ∼17.2 kg pre- and post-intervention, respectively.
DEXA. MICT group lower limb lean mass was 17.0 ± 2.8 and ∼17.3 kg pre- and post-intervention, respectively.
Boereboom Whole body and leg ➞ vs. pre-HIIT
et al. (2016) lean mass by DEXA. Lean mass was 45.2 ± 11.1 and 45.3 ± 11.1 kg pre- and post-HIIT, respectively.
M. vastus lateralis ➚ vs. pre-HIIT
muscle thickness Leg lean mass was 4.1 ± 1.3 and 4.2 ± 1.2 kg pre- and post-HIIT, respectively.
determined by m. vastus lateralis thickness was 2.04 ± 0.27 and 2.17 ± 0.28 cm pre- and post-HIIT, respectively.
ultrasonography.
Bruseghini et al. Whole body and lower ➞ vs. pre-HIIT, ➘ vs. resistance training
(2015) limb lean mass by HIIT group lean mass was 56.9 ± 6.2 and 57.7 ± 5.3 kg pre- and post-intervention, respectively.
DEXA. CSA and Resistance training group lean mass was 57.3 ± 5.9 and 57.6 ± 5.8 kg pre- and post-intervention, respectively.
volume of the ➚ vs. pre-HIIT, ➞ vs. resistance training
quadriceps by MRI. HIIT group total quadriceps CSA was 60.3 ± 10.6 and 62.9 ± 10.5 cm2 pre- and post-intervention, respectively.
Resistance training group total quadriceps CSA was 59.5 ± 9.3 and 62.0 ± 9.3 cm2 pre- and post-intervention, respectively.
HIIT group total quadriceps volume was 820 ± 198 and 865 ± 199 cm3 pre- and post-intervention, respectively.
Resistance training group total quadriceps volume was 812 ± 184 and 852 ± 188 cm3 pre- and post-intervention,
respectively.
Bruseghini et al. Volume and ACSA of ➚ vs. pre-HIIT, ➞ vs. resistance training
(2019) the quadriceps by Total quadriceps volume results are identical to Bruseghini et al. (2015).
MRI. HIIT group total quadriceps ACSA increased 3.09 ± 1.38, 2.27 ± 252, and 2.65 ± 3.04 cm2 at 25, 50, and 75% femur
length, respectively, compared to pre-intervention.
Resistance training group total quadriceps ACSA increased 3.19 ± 1.24, 3.03 ± 3.04, and 3.40 ± 3.21 cm2 at 25, 50, and
75% femur length, respectively compared to pre-intervention.
➞ vs. pre-HIIT, ➘ vs. resistance training
HIIT group PCSA at 50% femur length was unchanged post-intervention.
Resistance training group PCSA at 50% femur length increased post-intervention.
Buckinx et al. Whole body and leg ➞ vs. pre-HIIT
(2019) lean mass by DEXA. Lean mass was 51.8 ± 7.3 and 53.0 ± 7.9 kg pre- and post-HIIT, respectively, in a low protein group.
Thigh muscle area by Lean mass was 43.1 ± 9.3 and 43.4 ± 9.5 kg pre- and post-HIIT, respectively, in a high protein group.
pQCT. Leg lean mass was 18.4 ± 3.0 and 18.8 ± 3.3 kg pre- and post-HIIT, respectively, in a low protein group.
Leg lean mass was 15.4 ± 3.5 and 15.7 ± 3.5 kg pre- and post-HIIT, respectively, in a high protein group.
Thigh muscle area was 91.8 ± 11.9 and 94.4 ± 15.6 cm2 pre- and post-HIIT, respectively, in a low protein group.
Thigh muscle area was 99.3 ± 21.7 cm2 and 95.7 ± 21.8 cm2 pre- and post-HIIT, respectively, in a high protein group.
Coswig et al. Whole body lean mass ➞ vs. pre-HIIT, ➞ vs. MICT
(2020) by BIA. HIIT group lean mass was 29.4 ± 2.8 and 29.6 ± 2.7 kg pre- and post-intervention, respectively.
MICT group lean mass was 30.1 ± 3.5 and 29.9 ± 3.6 kg pre- and post-intervention, respectively.
Hayes et al. Whole body lean mass ➚ vs. pre-HIIT
(2017) by BIA. Lean mass was 66.7 ± 7.1 and 69.1 ± 8.3 kg pre- and post-HIIT, respectively.
Herbert et al. Whole body lean mass ➚ vs. pre-HIIT
(2017b) by BIA. Sedentary group lean mass was 66.7 ± 7.1 and 69.1 ± 8.3 kg pre- and post-HIIT, respectively.
Masters athlete group lean mass was 65.2 ± 6.4 and 67.9 ± 5.1 kg pre- and post-HIIT, respectively.
Hwang et al. Whole body lean mass ➞ vs. pre-HIIT, ➞ vs. control, ➞ vs. MICT
(2016) by DEXA. HIIT group lean mass was 44.6 ± 2.6 and 45.0 ± 2.4 kg pre- and post-intervention, respectively.
MICT group lean mass was 47.8 ± 2.1 and 47.7 ± 1.9 kg pre- and post-intervention, respectively.
Control group lean mass was 48.3 ± 2.9 and 48.4 ± 2.9 kg pre- and post-intervention, respectively.
Jiménez-García Whole body lean mass ➞ vs. pre-HIIT, ➞ vs. control, ➞ vs. MIIT
et al. (2019) by BIA. HIIT group lean mass was 24.9 ± 5.7 and 25.7 ± 6.7 kg pre- and post-intervention, respectively.
MIIT group lean mass was 25.6 ± 6.6 and 24.5 ± 6.3 kg pre- and post-intervention, respectively.
(Continued)

TABLE 3 | Continued

measurement
Malin et al. Whole body lean mass ➘ vs. pre-HIIT, ➞ vs. control
(2018) by BIA. HIIT group lean mass decreased 0.4 ± 0.1 kg from pre- to post-intervention.
Control group lean mass decreased 0.4 ± 0.1 kg from pre- to post-intervention
Martins et al. Whole body lean mass ➚ vs. pre-HIIT, ➞ vs. combined training
(2018) by DEXA, expressed HIIT group muscle mass index was 6.6 ± 0.7 and 6.8 ± 0.9 kg·m2 pre- and post-intervention, respectively.
as muscle mass index. Combined training group muscle mass index was 6.6 ± 1.1 kg and 6.8 ± 1.3 kg·m2 pre- and post-intervention, respectively.
Nunes et al. Whole body and leg ➞ vs. pre-HIIT, ➞ vs. combined training
(2019) lean mass by DEXA. HIIT group lean mass was 37.5 (33.9–41.1) kg and 37.5 (33.8–41.2) kg pre- and post-intervention, respectively.
Combined training group lean mass was 36.0 (32.7–39.2) kg and 36.3 (32.8–39.8) kg pre- and post-intervention, respectively.
➚ vs. pre-HIIT, ➞ vs. combined training
HIIT group leg lean mass was 12.7 (11.1–14.2) kg and 12.9 (11.3–14.6) kg pre- and post-intervention, respectively.
Combined training group leg lean mass was 12.3 (10.8–13.8) kg and 12.7 (11.1–14.4) kg pre- and post-intervention,
respectively.
Robinson et al. Whole body lean mass ➚ vs. pre-HIIT, ➞ vs. combined training, ➞ vs. resistance training
(2017) by DEXA. HIIT group increased fat free mass ∼0.9 kg from pre- to post-intervention.
Combine training group increased fat free mass ∼1.0 kg from pre- to post-intervention.
Resistance training group increased fat free mass ∼1.2 kg from pre- to post-intervention.
Sculthorpe et al. Whole body lean mass ➚ vs. pre-HIIT, ➚ vs. control
(2017) by BIA. HIIT group lean mass was 65.9 ± 6.7 and 68.1 ± 7.5 kg pre- and post-intervention, respectively.
Snijders et al. Whole body and leg ➞ vs. pre-HIIT
(2019) lean mass by DEXA. Lean mass was 55.0 ± 7.8 kg and 55.3 ± 7.7 kg pre- and post-HIIT, respectively.
Leg lean mass was 19.3 ± 3.6 kg and 19.5 ± 3.4 kg pre- and post-HIIT, respectively.
Søgaard et al. Whole body and leg ➞ vs. pre-HIIT
(2018) lean mass by DEXA. Female lean mass was 43.3 ± 1.0 and 43.7 ± 1.0 kg pre- and post-HIIT, respectively.
Male lean mass was 59.6 ± 2.0 and 60.0 ± 2.0 kg pre- and post-HIIT, respectively.
Female leg lean mass was 15.5 ± 0.4 kg and 15.5 ± 0.5 kg pre- and post-HIIT, respectively.
Male leg lean mass was 21.0 ± 0.7 and 21.2 ± 0.7 kg pre- and post-HIIT, respectively.
Søgaard et al. Whole body and leg ➚ vs. pre-HIIT
(2019) lean mass by DEXA. Lean mass was 51.5 ± 2.1 and 51.8 ± 2.1 kg pre- and post-HIIT, respectively.
Taylor et al. Whole body lean mass ➚ vs. pre-HIIT, ➞ vs. MICT
(2019) by MRI. HIIT group increased fat free mass 0.3 ± 0.9 kg from pre- to post-intervention.
MICT group increased fat free mass 0.9 ± 1.5 kg from pre- to post-intervention.
Wyckelsma et al. Whole body and leg Data not reported post-intervention
(2017) lean mass by DEXA.
DEXA, Dual-energy X-ray absorptiometry; MRI, Magnetic resonance imaging; CSA, Cross sectional area; ACSA, Anatomical cross-sectional area; pQCT, peripheral quantitative computed
tomography; BIA, bioelectrical impedance analysis; MICT, Moderate intensity continuous training; MIIT, Moderate intensity interval training; ➚, superior to; ➘, worse than; ➞, equal to
(according to statistical interpretation of original authors). Data are presented as mean ± standard deviation or mean (95% confidence intervals).
and research studies (Cruz-Jentoft et al., 2019). However, of gripping. If the two proposed measures of muscle strength to
these six investigations, two were published before the revised diagnose sarcopenia are not in agreement, then an alternative
EWGSOP guidelines, and four were published the same year, method for measuring muscle strength is necessary in this
so data collection may have been pre-update. Wiśniowska- population. This may explain why most studies in this review
Szurlej et al. (2019) examined handgrip strength and other have not measured handgrip and instead opted for isokinetic
mobility parameters including gait speed, balance, and chair dynamometry, considered the gold standard for assessing muscle
stand and observed weak correlations between handgrip strength strength but not commonly used in a clinical setting. When
and mobility in older adults under long-term care facilities. considering the body of studies examining muscle function, the
Yee et al. (2021) corroborated this finding reporting weak majority report increased strength (70% of studies) or power
correlations between chair stand test and handgrip strength in (100% of studies) following HIIT.
community-dwelling older adults. Similarly, changes in handgrip Considering reduced muscle function is at the forefront
strength do correlate with changes in leg muscle strength of of the recent update on the definition and treatment of
physical performance during an exercise intervention program sarcopenia (Cruz-Jentoft et al., 2019), any intervention targeting
in frail older people (Tieland et al., 2015), suggesting it is the prevention or reversal of phenotypic characteristics of
not a good surrogate of mobility, muscle function, or change sarcopenia must be capable of enhancing muscle strength. To
in muscle function of muscle other than those involved in our knowledge, Losa-Reyna et al. (2019) is the only investigation

TABLE 4 | Summary of study details concerning HIIT and physical performance.

measurement
Aboarrage TUG ➚ vs. pre-HIIT, ➚ vs. control

Junior et al. HIIT group TUG was 6.86 ± 1.24 and 6.22 ± 1.13 s pre- and post-intervention, respectively.
(2018) Control group TUG was 5 ± 1 and 6 ± 1 s pre- and post-intervention, respectively.
Adamson et al. TUG ➚ vs. pre-HIIT, ➚ vs. control
(2014) HIIT group TUG was 6.5 ± 0.8 and 5.8 ± 0.6 s pre- and post-intervention, respectively.
Control group TUG was 6.9 ± 1.0 and 6.7 ± 1.0 s pre- and post-intervention, respectively.
Adamson et al. TUG ➚ vs. pre-HIIT, ➚ vs. control
(2020) HIIT once weekly group TUG was 6.7 ± 0.9 and 6.2 ± 0.7 s pre- and post-intervention, respectively.
HIIT twice weekly TUG was 7.0 ± 1.2 and 5.9 ± 0.5 s pre- and post-intervention, respectively.
Ballesta-García TUG 6MWT ➚ vs. pre-HIIT, ➚ vs. control
et al. (2019) HIIT group TUG was 6.08 ± 1.31 and 5.30 ± 0.80 s pre- and post-intervention, respectively.
MICT group TUG was 6.40 ± 1.23 and 5.53 ± 1.28 s pre- and post-intervention, respectively.
HIIT group 6MWT was 564 ± 41.0 and 600 ± 74.9 m pre- and post-intervention, respectively.
MICT group 6MWT was 502 ± 72.3 and 545 ± 72.6 m pre- and post-intervention, respectively.
Control group 6MWT was 510 ± 59.0 and 494 ± 49.5 m pre- and post-intervention, respectively.
Bartlett et al. TUG 400 m walk ➞ vs. pre-HIIT
(2018) TUG was 8.8 ± 1.8 and 8.4 ± 1.9 s pre- and post-intervention, respectively.
➚ vs. pre-HIIT
400 m walk was 251 ± 62 and 233 ± 51 s pre- and post-intervention, respectively.
Buckinx et al. TUG 6MWT ➚ vs. pre-HIIT
(2018) HIIT group TUG was 7.5 ± 1.1 and 6.6 ± 0.9 s pre- and post-intervention, respectively.
HIT group 6MWT was 550 ± 85 and 618 ± 91 m pre- and post-intervention, respectively.
Coetsee and TUG ➞ vs. pre-HIIT, ➞ vs. control, ➞ vs. MICT, ➞ vs. resistance training
Terblanche HIIT group TUG was 5.6 ± 0.7 and 5.3 ± 0.7 s pre- and post-intervention, respectively.
(2017) Control group TUG was 5.5 ± 1.1 and 5.7 ± 0.8 s pre- and post-intervention, respectively.
MICT group TUG was 5.6 ± 0.7 and 5.4 ± 0.8 s pre- and post-intervention, respectively.
RT group TUG was 5.4 ± 0.9 and 5.1 ± 0.8 s pre- and post-intervention, respectively.
Coswig et al. Gait speed (10 m) 6MWT ➞ vs. pre-HIIT, ➞ vs. MIIT, ➞ vs. MICT
(2020) HIIT group gait velocity was 1.3 ± 0.1 and 1.3 ± 0.1 m·s−1 pre- and post-intervention, respectively.
MIIT group gait velocity was 1.3 ± 0.1 and 1.2 ± 0.1 m·s−1 pre- and post-intervention, respectively.
MICT group gait velocity was 1.3 ± 0.1 and 1.3 ± 0.1 m·s−1 pre- and post-intervention, respectively.
➚ vs. pre-HIIT, ➞ vs. MIIT, ➞ vs. MICT
HIIT group 6MWT was 406 ± 74 and 454 ± 72 m pre- and post-intervention, respectively.
MIIT group 6MWT was 403 ± 83 and 451 ± 84 m pre- and post-intervention, respectively.
MICT group 6MWT was 413 ± 58 and 427 ± 68 m pre- and post-intervention, respectively.
Guadalupe-Grau TUG 6MWT ➚ vs. pre-HIIT
et al. (2017) TUG was 9.1 ± 1.6 and 7.0 ± 0.9 s pre- and post-intervention, respectively.
6MWT was 286.1 ± 107.2 and 396.2 ± 106.5 m pre- and post-intervention, respectively.
Jiménez-García Gait speed (via TUG test) ➚ vs. pre-HIIT, ➚ vs. MIIT, ➚ vs. control
et al. (2019) HIIT group gait speed was 0.73 and 0.89 m·s−1 pre- and post-intervention, respectively.
MIIT group gait speed was 0.75 and 0.75 m·s−1 pre- and post-intervention, respectively.
Control group gait sped was 0.75 and 0.75 m·s−1 pre- and post-intervention, respectively.
Losa-Reyna SPPB 6MWT ➚ vs. pre-HIIT, ➚ vs. control
et al. (2019) HIIT group SPPB was 6.8 ± 1.5 points and 9.8 ± 1.5 points pre- and post-intervention, respectively.
Control group SPPB was 7.4 ± 2.0 points and 6.9 ± 2.7 points pre- and post-intervention, respectively.
➞ vs. pre-HIIT
6MWT was 257 ± 62 and 302 ± 72 m pre- and post-intervention, respectively.
6MWT was not performed in the control group.
Martins et al. 6MWT ➚ vs. pre-HIIT, ➞ vs. combined training
(2018) HIIT group 6MWT was 577 ± 83 and 600 ± 92 m pre- and post-intervention, respectively.
Combined training group 6MWT was 614 ± 89 and 669 ± 105 m pre- and post-intervention,
respectively.
TUG, timed up and go; 6MWT, 6-min walk test; SPPB, short physical performance battery; HIIT, high intensity interval training; MICT, moderate intensity continuous training; MIIT,
Moderate intensity interval training; ➚, superior to; ➘, worse than; ➞, equal to (according to statistical interpretation of original authors). Data are presented as mean ± standard
deviation or mean (95% confidence intervals).

to examine an exercise intervention containing HIIT in frail et al., 2019). However, this was not observed as Aboarrage
older adults. These authors examined the influence of a 6-week Junior et al. (2018) utilized an all-out protocol, with no reported
multicomponent exercise intervention (including walking-based increases in lean mass. Likewise, it may have been expected
HIIT) focused on enhancing muscle power in ∼84-year olds untrained participants would exhibit the greatest increase in
(range 77–96 years; 75% females; 35% pre-frail and 65% frail). muscle quantity. However, Herbert et al. (2017a) examined the
Post-intervention, leg press strength had improved by 34%, and body composition changes in a group of previously sedentary
muscle power improved by 47%. Moreover, load at peak power older males and masters athletes, and reported FFM increased
on the force-velocity curve increased by 23%, which suggests this ∼3% (from ∼67 to ∼69 kg) and ∼4% (from ∼65 to ∼68 kg),
type of intervention may improve muscle strength and power in respectively. This suggests HIIT may be efficacious at increasing
frail and pre-frail elderly. FFM in highly active older males and previously sedentary older
male, if they are HIIT-naïve. Yet, these data are not ubiquitous
HIIT and Muscle Quantity or Quality through the included literature of this review. Adequate intake
In this review, 20/21 (95%) of studies report appendicular skeletal of dietary protein is also an important consideration for older
muscle mass measured by DEXA, BIA, or MRI, or cross-sectional adults and any potential exercise induced increases in muscle
area of the thigh by MRI or pQCT scan, which are the primary mass are likely to be influenced by this (Beaudart et al.,
measurement of muscle quantity proposed by EWGSOP in 2019).
clinical practice and research (Cruz-Jentoft et al., 2019). The
remaining investigation used air plethysmography to determine HIIT and Physical Performance
whole body lean mass (Andonian et al., 2018). When considering In this review, all of the studies assessing physical performance
the body of studies examining total body lean mass, several reported gait speed (part of the SPPB), the SPPB, or the TUG
reported no increase from pre-HIIT (Bruseghini et al., 2015; test as an outcome, which are the primary measurements of
Boereboom et al., 2016; Hwang et al., 2016; Andonian et al., physical performance proposed by EWGSOP in clinical practice
2018; Malin et al., 2018; Søgaard et al., 2018; Beetham et al., and research (Cruz-Jentoft et al., 2019). Four investigations also
2019; Buckinx et al., 2019; Jiménez-García et al., 2019; Nunes reported the 5 repetitions chair stand test separately (Adamson
et al., 2019; Snijders et al., 2019; Coswig et al., 2020), whereas et al., 2014, 2020; Losa-Reyna et al., 2019; Nunes et al., 2019).
some reported an increase post-HIIT compared to pre-HIIT However, this is one element of the SPPB, so those reporting
(Hayes et al., 2017; Herbert et al., 2017a; Sculthorpe et al., SPPB values will have conducted this test. When considering the
2017). To add further uncertainty, two studies which observed body of literature examining physical performance, all studies
no increase in whole body lean quantity observed increased thigh reported improvements post-HIIT. When considering studies
lean mass (Boereboom et al., 2016; Bruseghini et al., 2019). Taken examining physical performance, all studies report increased
together, it is unclear whether HIIT can significantly increase physical performance of ≥1 parameter following HIIT. In
muscle quantity or quality, and the result may be determined by some instances HIIT did not improve performance more than
measurement technique of muscle quantity. another training method, where investigations had a parallel
There are no data concerning the effect of HIIT on skeletal arm (Martins et al., 2018; Ballesta-García et al., 2019; Nunes
muscle quantity or its surrogates (e.g., fat free mass [FFM], lean et al., 2019). Physical performance represents a multidimensional
body mass) in adults diagnosed with sarcopenia, or oldest old construct involving a range of physiological systems across the
humans, despite emerging evidence in the rodent model (Seldeen whole-body (Beaudart et al., 2019) and is a key component in the
et al., 2018). Thus, data from the middle old and young old definition of severe sarcopenia (Cruz-Jentoft et al., 2019).
must be extrapolated until these studies exist. In this context, Losa-Reyna et al. (2019) observed that a 6-week
and despite no changes in muscle strength, Robinson et al. multicomponent exercise intervention (including walking-
(Robinson et al., 2017) observed a ∼1 kg increase in FFM in based HIIT) focused on enhancing muscle power improved the
sedentary ∼71 year olds following 3 days/week cycling HIIT and frailty phenotype by 1.6 points, muscle strength by 34%, and
2 days/week of treadmill walking. This increase was greater in muscle power by 47%, suggesting this type of intervention is
a resistance training only group, however. Interestingly, FFM feasible in frail and pre-frail elderly. As this intervention was
was also increased to the same extend in a young (∼25 years multicomponent, it is not possible to quantify the contribution
old) sedentary cohort, suggesting HIIT can increase FFM in the of HIIT to the overall improvement, and therefore it is difficult
young and old to equal magnitude. This can be interpreted in two to ascertain whether adaptations would have occurred were
ways: 1) sedentary older adults maintain muscle plasticity and HIIT examined in isolation, rather than simultaneously with a
sensitivity to HIIT into older age, and 2) HIIT can increase FFM resistance training programme.
quantity in young sedentary adults who have not experienced
muscle wastage. However, as all participants were untrained, Strengths and Limitations
increased FFM could be attributed to both young and old In cataloging the research concerning HIIT and phenotypic
participants being HIIT-naïve. characteristics of sarcopenia, several issues and considerations
It would have been a reasonable a priori hypothesis to predict came to light, all of which have important implications for the
HIIT performed at the greatest relative intensity (i.e., all-out or interpretation of this body of literature, and improvement of
SIT) would result in the greatest increases in muscle quantity, as future investigations. Firstly, the use of exercise terminology
intensities closer to maximal voluntary contraction are known requires clarity. In this context, we mean the definition of
to induce muscle hypertrophy (Schoenfeld, 2010; Krzysztofik “HIIT.” HIIT has previously been described as periods of work

>85% VO2peak or 85% HRmax or equivalent perception-based HIIT is a feasible exercise approach in older people. Secondly,
approaches, interspersed by recovery periods (Gibala et al., 2012). given the issue regarding terminology and exercise intensity
Only articles matching this description were included in this discussed above, authors are encouraged to be consistent in the
article. Several articles were returned from our database searching use of exercise terminology by adhering to the consensus on
which termed the exercise intervention HIIT, but often these did exercise reporting template [CERT; (Slade et al., 2016)] in future
not reach this threshold of intensity. Similarly, when exercise investigations, which would permit assessment of intervention
is described as “all-out,” this should be termed SIT, which heterogeneity. Thirdly, studies included within this review had
although a subcategory of HIIT, is unique in its prescription a sample size ranging from 8 to 82 participants, possibly due
(Weston et al., 2014). It is imperative to classify protocols to resource commitments associated with having large sample
based on the nature of exercise prescription as different interval sizes and/or rigorous research design. We suggest multicentre
exercise classifications will alter experience and potentially RCTs to improve (a) statistical power, and (b) the quality
subsequent adaptation to the exercise (Biddle and Batterham, of available evidence, as only 17/32 studies achieved ≥5 on
2015). Penultimately, the majority of studies considered small the PEDro scale. Finally, although this review focused directly
samples sized, which limits interpretation. Finally, the major on phenotypic characteristics of sarcopenia (i.e., quantitative
limitation of the present scoping review is the lack of studies assessment), qualitative investigations on the perceptions of
in older adults diagnosed with sarcopenia. Whilst the literature adults with phenotypic characteristics of sarcopenia on this type
assessment was comprehensive, it is possible that studies may of exercise and how it could be delivered to this population
have been missed from the analysis, but as three databases were with minimizing any barriers will be beneficial for the field
searched, it is unlikely enough were missed to create a large void of gerontology.
in the included literature.
One questions that cannot be answered in the current scoping
CONCLUSIONS AND PRACTICAL
review is the effect of age on adaptations in physical performance,
muscle function, or muscle quantity with HIIT. Whilst we RECOMMENDATIONS
attempted to examine results by decade (60–69, 70–79, and ≥80
In conclusion, most studies presented herein utilized outcome
years of age), it was noted that most published results were
measures defined by the revised EWGSOP guidelines. There
performed in “younger old” participants between 60 and 70
was divergence observed in exercise interventions, with HIIT
years of age. Further meta-analytical subgroup analysis or meta-
interventions involving a range of exercise modes delivered in a
regression may thus be required to examine differing responses
range of settings. Currently, there is some evidence suggesting
by age group. In a similar manner, another limitation noted is
HIIT may improve phenotypic characteristics of sarcopenia.
the inability to examine potential sex differences in responses to
However, there are few studies investigating any form of HIIT in
HIIT for any outcome. Whilst most studies utilized both male
the very old, or those diagnosed with sarcopenia. Therefore, more
and female participants, groups were typically mixed and thus no
intervention studies are needed in this population to confirm
insight into sex difference of HIIT responses is attempted here.
this phenomenon and confidently quantify the effectiveness of
With a need to better describe and report female physiology in
HIIT. In addition, we need to understand if this is a safe and
exercise physiology literature (Elliott-Sale et al., 2021), more work
feasible training approach in this population. In a practical
in this area may this be called for.
context, combined interventions involving HIIT and resistance
It is also important to acknowledge that the studies included in
training are a worthy avenue for investigation as resistance
this review were delivered across a range of settings and involved
training is the most potent stimulus to increase muscle quantity
a diverse range of older adults of varying health and fitness status.
and studies herein showed divergent results concerning HIIT
While this makes generalizing findings difficult, it does suggest
and muscle quantity. Finally, HIIT or SIT that is easy to apply
that HIIT may be feasible across a broad range of settings with
(i.e., without equipment needs, travel, specialist training, and
a wide range of older people. However, it is important to make
intensity monitoring such as heart rate or power output) or can
clear that HIIT may not be suitable for all older people and all
be supported virtually is likely needed to promote the transition
exercise programmes should be individually prescribed based on
of HIIT from the laboratory to the real world.
the characteristics of the individual.
DATA AVAILABILITY STATEMENT

Recommendations for Advancement of the
Investigative Area The original contributions presented in the study are included
In relation to our fourth objective (provide recommendations in the article/Supplementary Material, further inquiries can be
for the advancement of the investigative area), this review directed to the corresponding authors.
revealed a dearth of studies considering participants diagnosed
with sarcopenia. Therefore, our primary recommendation for AUTHOR CONTRIBUTIONS
advancement of the research area is to increase studies that
recruit participants or patients with sarcopenia, or those who are LH and CH: conceptualization, methodology, investigation,
at risk from sarcopenia (i.e., the oldest old). These studies could and project administration. LH and NS-H: formal analysis
be feasibility trials, as there is little information as to whether and investigation. LH, BE, ZY, TB, NS, NS-H, and

CH: writing—original draft preparation. LH, BE, TB, NS, SUPPLEMENTARY MATERIAL
NS-H, and CH: writing—review and editing. LH and BE:
visualization. LH and CH: funding acquisition. All authors The Supplementary Material for this article can be found
contributed to the article and approved the submitted version. online at: https://www.frontiersin.org/articles/10.3389/fphys.
2021.715044/full#supplementary-material
Supplementary Figure 1 | Percent change (1%) in outcome measures for
ACKNOWLEDGMENTS muscle function (a) 5 s chair stand, (b) 30 s chair stand, (c) grip strength, muss
quality (d) lean mass, or muscle performance (e) timed up and go (TUG), and (f)
The authors wish to acknowledge the support of respective 6 min walk test (6MWT), all as a function of the number of bouts completed.
employers in preparation of this review. Dashed lines indicate 95% confidence intervals.
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High Intensity Interval Training (HIIT) As A Potential Countermeasure For Phenotypic Characteristics of Sarcopenia: A Scoping Review

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SYSTEMATIC REVIEW

published: 24 August 2021

High Intensity Interval Training (HIIT)

Frontiers in Physiology | www.frontiersin.org 1 August 2021 | Volume 12 | Article 715044

in Improving muscle function and physical performance compared to non-exercised

KEY POINTS in mitochondrial function (Melov et al., 2007) and reduced

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Data Items Study Characteristics

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HIIT and Sarcopenia Scoping Review

postmenopausal (if female), programme was progressed. scale

HIIT and Sarcopenia Scoping Review

HIIT and Sarcopenia Scoping Review

non-smokers. ClinicalTrials.gov 60 s with 60 s rest on a cycle

HIIT and Sarcopenia Scoping Review

a multicomponent intervention (Guadalupe-Grau et al., 2017;

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TABLE 2 | Summary of study details concerning HIIT and muscle function.

Reference Method of outcome Summary of results

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Reference Method of outcome Summary of results

Guadalupe-Grau 30 s chair stand test ➚ vs. pre-HIIT

Snijders et al. 1-RM leg press, chest ➚ vs. pre-HIIT

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Reference Method of outcome Summary of results

Hurst et al. Leg extensor power. ➚ vs. pre-HIIT, ➚ vs. control,

DISCUSSION included studies involved participants who had been diagnosed

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Reference Method of outcome Summary of results

Aboarrage Whole body lean mass ➞ vs. control

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Reference Method of outcome Summary of results

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TABLE 4 | Summary of study details concerning HIIT and physical performance.

Reference Method of outcome Summary of results

Aboarrage TUG ➚ vs. pre-HIIT, ➚ vs. control

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DATA AVAILABILITY STATEMENT

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